Brain tumour microstructure is associated with post-surgical cognition.

Brain tumour microstructure is potentially predictive of changes following treatment to cognitive functions subserved by the functional networks in which they are embedded. To test this hypothesis, intra-tumoural microstructure was quantified from diffusion-weighted MRI to identify which tumour subregions (if any) had a greater impact on participants' cognitive recovery after surgical resection. Additionally, we studied the role of tumour microstructure in the functional interaction between the tumour and the rest of the brain. Sixteen patients (22-56 years, 7 females) with brain tumours located in or near speech-eloquent areas of the brain were included in the analyses. Two different approaches were adopted for tumour segmentation from a multishell diffusion MRI acquisition: the first used a two-dimensional four group partition of feature space, whilst the second used data-driven clustering with Gaussian mixture modelling. For each approach, we assessed the capability of tumour microstructure to predict participants' cognitive outcomes after surgery and the strength of association between the BOLD signal of individual tumour subregions and the global BOLD signal. With both methodologies, the volumes of partially overlapped subregions within the tumour significantly predicted cognitive decline in verbal skills after surgery. We also found that these particular subregions were among those that showed greater functional interaction with the unaffected cortex. Our results indicate that tumour microstructure measured by MRI multishell diffusion is associated with cognitive recovery after surgery.

Assessment of neuropsychological function in brain tumor treatment: a comparison of traditional neuropsychological assessment with app-based cognitive screening.

BACKGROUND: Gliomas are typically considered to cause relatively few neurological impairments. However, cognitive difficulties can arise, for example during treatment, with potential detrimental effects on quality of life. Accurate, reproducible, and accessible cognitive assessment is therefore vital in understanding the effects of both tumor and treatments. Our aim is to compare traditional neuropsychological assessment with an app-based cognitive screening tool in patients with glioma before and after surgical resection. Our hypotheses were that cognitive impairments would be apparent, even in a young and high functioning cohort, and that app-based cognitive screening would complement traditional neuropsychological assessment. METHODS: Seventeen patients with diffuse gliomas completed a traditional neuropsychological assessment and an app-based touchscreen tablet assessment pre- and post-operatively. The app assessment was also conducted at 3- and 12-month follow-up. Impairment rates, mean performance, and pre- and post-operative changes were compared using standardized Z-scores. RESULTS: Approximately 2-3 h of traditional assessment indicated an average of 2.88 cognitive impairments per patient, while the 30-min screen indicated 1.18. As might be expected, traditional assessment using multiple items across the difficulty range proved more sensitive than brief screening measures in areas such as memory and attention. However, the capacity of the screening app to capture reaction times enhanced its sensitivity, relative to traditional assessment, in the area of non-verbal function. Where there was overlap between the two assessments, for example digit span tasks, the results were broadly equivalent. CONCLUSIONS: Cognitive impairments were common in this sample and app-based screening complemented traditional neuropsychological assessment. Implications for clinical assessment and follow-up are discussed.

The care of older cancer patients in the United Kingdom.

The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient's biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one's fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer.

A Wearable Textile Thermograph.

In medicine, temperature changes can indicate important underlying pathologies such as wound infection. While thermographs for the detection of wound infection exist, a textile substrate offers a preferable solution to the designs that exist in the literature, as a textile is very comfortable to wear. This work presents a fully textile, wearable, thermograph created using temperature-sensing yarns. As described in earlier work, temperature-sensing yarns are constructed by encapsulating an off-the-shelf thermistor into a polymer resin micro-pod and then embedding this within the fibres of a yarn. This process creates a temperature-sensing yarn that is conformal, drapeable, mechanically resilient, and washable. This work first explored a refined yarn design and characterised its accuracy to take absolute temperature measurements. The influence of contact errors with the refined yarns was explored seeing a 0.24 ± 0.03 measurement error when the yarn was held just 0.5 mm away from the surface being measured. Subsequently, yarns were used to create a thermograph. This work characterises the operation of the thermograph under a variety of simulated conditions to better understand the functionality of this type of textile temperature sensor. Ambient temperature, insulating material, humidity, moisture, bending, compression and stretch were all explored. This work is an expansion of an article published in The 4th International Conference on Sensor and Applications.

Prevention of falls in hospital.

Falls among inpatients are the most frequently reported safety incident in NHS hospitals. 30-50% of falls result in some physical injury and fractures occur in 1-3%. No fall is harmless, with psychological sequelae leading to lost confidence, delays in functional recovery and prolonged hospitalisation. Yet falls are not true accidents and there is evidence that a coordinated multidisciplinary clinical team approach can reduce their incidence. Identification of multiple underlying risk factors coupled with clear interventions to ameliorate the impact of each has been shown to reduce the incidence of inpatient falls by 20-30%. The implementation of complex multiprofessional interventions is challenging and successful schemes seek to nurture a culture of vigilant safety consciousness in all staff at the clinical interface. Strong leadership and organisational oversight help to combine this cultural evolution with relevant evidence and rigorous measurement of performance in order to improve patient safety. The results of national audit suggest that NHS acute hospitals could do more to reduce the incidence of falls among inpatients.

Mathematical approaches to modeling development and reprogramming.

Induced pluripotent stem cells (iPSCs) are created by the reprogramming of somatic cells via overexpression of certain transcription factors, such as the originally described Yamanaka factors: Oct4, Sox2, Klf4, and c-Myc (OSKM). Here we discuss recent advancements in iPSC reprogramming and introduce mathematical approaches to help map the landscape between cell states during reprogramming. Our modelization indicates that OSKM expression diminishes and/or changes potential barriers between cell states and that epigenetic remodeling facilitate these transitions. From a practical perspective, the modeling approaches outlined here allow us to predict the time necessary to create a given number of iPSC colonies or the number of reprogrammed cells generated in a given time. Additional investigations will help to further refine modeling strategies, rendering them applicable toward the study of the development and stability of cancer cells or even other reprogramming processes such as lineage conversion. Ultimately, a quantitative understanding of cell state transitions might facilitate the establishment of regenerative medicine strategies and enhance the translation of reprogramming technologies into the clinic.

Using third-party financing to help today's patient pay for treatment and care.

Patients walking into your practice today are different than the ones you saw a few years ago. Larger deductibles and out-of-pocket costs may cause many of them to put off recommended treatment. What can you do to ease patients' cost concerns and help them move forward with the care they want and need? Creating a comprehensive financial policy that includes a third-party patient financing program is a good place to start. Here's how to ensure that you select the best program for you.

Unintentional silver intoxication following self-medication: an unusual case of corticobasal degeneration.

Silver toxicity is a rare condition. The most notable feature is a grey-blue discoloration of the skin, argyria, although harmful effects on the liver and kidney may be seen in severe cases. Neurological symptoms are an unusual consequence of silver toxicity. So far no effective treatment has been described for this metal overdose. We report the case of a 75-year-old man who had a history of self-medication with colloidal silver and presented with myoclonic seizures.

Pre-planning does a power of good.

Power quality is a serious, and often costly, issue in healthcare, especially when equipment is prone to fail without warning. Powervar's Rob Morris considers how sensitive medical equipment can be effectively protected against power surges, spikes, electrical noise and large value transients so as to maximise the chances of it keeping operating efficiently.

Predicting falls in older women.

Falls among older people are common and their occurrence is associated with detrimental effects on physical and psychosocial functioning. However, falls are not an inevitable consequence of ageing and there is growing evidence of effective interventions to prevent them. Accurate screening methods to identify high-risk populations are important if such strategies are to be cost-efficient. Epidemiological studies have identified a diverse group of risk factors for falls of different types in a variety of settings and patient groups. These have proved useful in delineating high-risk groups and have propagated a range of risk assessment tools for falls. Without an accepted taxonomy for the reporting of trials testing these instruments, direct comparison of results has been difficult. In frail older people, 'multi factorial assessment tools' have achieved some utility in the discrimination of fallers from non-fallers, whereas performance-based 'functional mobility assessments' appear to be more suited to predicting falls in groups of more active elders. The predictive value of these measures has been hampered by the complex and dynamic interaction between attendant risk factors and their variable influence in populations of different frailty profiles. Furthermore, current indices used in the prediction of falls are built upon statistical methodologies employing logistic regression, which fail to account for the breadth and depth of these associations in populations at risk of falling. Statistical representations more consistent with the complex modelling required in the design of falls risk assessment trials, such as tree classification techniques, may provide better results in future studies that aim to generate accurate predictors of falls.

A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: a cohort study.

BACKGROUND: people with vertebral fractures are at high risk of developing hip fractures. Falls risk is important in the pathogenesis of hip fractures. AIM: to investigate if balance tests, in conjunction with a falls history, can predict falls in older women with vertebral fractures. METHODS: a cohort study of community-dwelling women aged over 60 years, with vertebral fractures. Balance tests investigated were: 5 m-timed-up-and-go-test (5 m-TUG), timed 10 m walk, TURN180 test (number of steps to turn 180 degrees ), tandem walk, ability to stand from chair with arms folded. Leg extensor power was also measured. OUTCOME MEASURE: fallers (at least one fall in a 12 month follow-up period) versus non-fallers. RESULTS: one hundred and four women aged 63-91 years [mean=78 +/- 7], were recruited. Eighty-six (83%) completed the study. Four variables were significantly associated with fallers: previous recurrent faller (2+ falls) [OR=6.52; 95% CI=1.69-25.22], 5 m-TUG test [OR=1.03; 1.00-1.06], timed 10 m walk [OR=1.07; 1.01-1.13] and the TURN180 test [OR=1.22; 1.00-1.49] [P <0.05]. Multi-variable analysis showed that only two variables, previous recurrent faller [OR=5.60; 1.40-22.45] and the 5 m-TUG test [OR=1.04; 1.00-1.08], were independently significantly associated with fallers. The optimal cut-off time for performing the 5 m-TUG test in predicting fallers was 30 s (area under ROC=60%). Combining previous recurrent faller with the 5 m-TUG improved prediction of fallers [OR=16.79, specificity=100%, sensitivity=13%]. CONCLUSIONS: a previous history of recurrent falls and the inability to perform the 5 m-TUG test within 30 s predicted falls in older women with vertebral fractures. Combining these two measures can predict fallers with a high degree of specificity (although a low sensitivity), allowing the identification of a group of patients suitable for fall and fracture prevention measures.

Multifactorial day hospital intervention to reduce falls in high risk older people in primary care: a multi-centre randomised controlled trial [ISRCTN46584556].

Falls in older people are a major public health concern in terms of morbidity, mortality and cost. Previous studies suggest that multifactorial interventions can reduce falls, and many geriatric day hospitals are now offering falls intervention programmes. However, no studies have investigated whether these programmes, based in the day hospital are effective, nor whether they can be successfully applied to high-risk older people screened in primary care. The hypothesis is that a multidisciplinary falls assessment and intervention at Day hospitals can reduce the incidence of falls in older people identified within primary care as being at high risk of falling. This will be tested by a pragmatic parallel-group randomised controlled trial in which the participants, identified as at high risk of falling, will be randomised into either the intervention Day hospital arm or to a control (current practice) arm. Those participants preferring not to enter the full randomised study will be offered the opportunity to complete brief diaries only at monthly intervals. This data will be used to validate the screening questionnaire. Three day hospitals (2 Nottingham, 1 Derby) will provide the interventions, and the University of Nottingham's Departments of Primary Care, the Division of Rehabilitation and Ageing Unit, and the Trent Institute for Health Service Research will provide the methodological and statistical expertise. Four hundred subjects will be randomised into the two arms. The primary outcome measure will be the rate of falls over one year. Secondary outcome measures will include the proportion of people experiencing at least one fall, the proportion of people experiencing recurrent falls (>1), injuries, fear of falling, quality of life, institutionalisation rates, and use of health services. Cost-effectiveness analyses will be performed to inform health commissioners about resource allocation issues. The importance of this trial is that the results may be applicable to any UK day hospital setting. SITES: General practices across Nottinghamshire and Derbyshire. Day hospitals:Derbyshire Royal Infirmary (Southern Derbyshire Acute Hospitals NHS Trust)Sherwood Day Service (Nottingham City Hospital Trust)Leengate Day Hospital (Queen's Medical Centre Nottingham University Hospital NHS Trust).